May 22: Week That Was in Healthcare Fraud and Malpractice
By - Here is a general roundup of the past week’s developments in healthcare fraud and malpractice, as reported by the Department of Justice and the Office of Inspector General. The crimes reported below result in multiple millions of dollars in healthcare fraud and the possibility of extensive prison time.
Pretend doctors involved in $11.5M MI Medicare fraud scheme
Hicham Elhorr, MD, owner of Michigan-based House Calls Physicians PLLC, pleaded guilty this week to one count of conspiracy to commit healthcare fraud.
Elhorr and others billed Medicare for alleged in-home physician services that were not actually provided by licensed physicians. These individuals conducted home visits as pretend doctors. They also prepared medical documentation later signed by Elhorr and other licensed physicians to falsely affirm visits had been successfully completed when beneficiaries had actually not been treated. Visits were billed as if licensed physicians had been present to administer services when such was also untrue.
House Call Physicians billed Medicare for $11.5 million for physician home service expenses between 2008 and 2012. Elhorr admitted he instigated the submission of over $4 million in false and fraudulent claims.
Deceased patients billed in $4.5M IL Medicare scheme
Medical professionals were reported as working over 24 hours in a day in connection with an Illinois-based $4.5 million healthcare fraud scheme.
Rick E. Brown, President of Home Care America, Inc, controlled Medicall Physicians Group Ltd in conjunction with the company’s biller, Mary C. Talaga. Both Brown and Talaga falsely billed Medicare for non-rendered services. Medicare was billed for services rendered to deceased patients. Such services were reported as being provided by medical professions who were no longer employed there.
According to evidence, Brown forged physician signatures on medical documentation. Additionally, Talaga guided physicians in the creation of fabricated documentation.
Brown and Talaga were each found guilty of 1 count of conspiracy to commit healthcare fraud, 6 counts of healthcare fraud, and 3 counts of false statements relating to healthcare matter. Medicall submitted almost $12 million in claims to Medicare, over a third of which were fraudulent.
Medicare compliance failure, Saint Anthony’s Medical Center
Missouri-based Saint Anthony’s Medical Center failed to fully comply with Medicare billing requirements for 53 claims. According to the Office of the Inspector General and the Department of Health and Human Services, overpayments totaled $309,000. Additionally, overpayments of $118,000 occurred due to billing errors within 23 inpatient claims; overpayments of $191,000 resulted due to billing errors within 30 outpatient claims. Such errors happened due to a lack of adequate controls in place to prevent erroneous billing of Medicare claims.
Recommendations to the hospital include refunding the Medicare contractor over $308,000, consisting of over $190,000 in overpayments for the incorrectly billed outpatient and inpatient claims. An additional recommendation is a tightening of controls to ensure Medicare requirements are correctly adhered to.
